New Affiliate Chapter Application

New Affiliate Chapter Application

Thank you for your interest in establishing an Affiliate Chapter of Sisters Network Inc.
Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Are you a Survivor?
Are you in Active Treatment?
Please describe how you heard about Sisters Network Inc
Why are you interested in establishing an affiliate chapter?
Briefly describe how you will bring the mission and goal of Sisters Network Inc to life in your community.
What local contacts and relationships do you have that will help you support a Sisters Network Affiliate Chapter?
Briefly describe the support you would need from National Headquarters should you become an Affiliate Chapter.
Proposed Chapter Location
(City/State)
List 3 Sisters Network Affiliate Chapters closest to your proposed location.
What percentage of the population in your city identifies as African American? (Tip: Check your city’s official website for demographic data or contact a local elected official’s office for assistance.)
Please list the ZIP codes that your Affiliate Chapter will serve. (Tip: You can reference a county ZIP code map to identify the areas you plan to cover.)
Do you have fundraising experience? If so, please provide 2-3 examples.
Please share some initial ideas on how you plan to fundraise to support your Affiliate Chapter’s activities.
What are some outreach programs you would like to implement in the community to raise breast cancer awareness?
Please list your current community service involvement.
Please attach a headshot and biography (as it relates to breast cancer)

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New Affiliate Chapter Application

Please List the (5) Executive Members below